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2018 HAZARDOUS WASTE GENERATOR …

FACILITY NAME:This form must be submitted if your facility produces HAZARDOUS WASTE . You must reportANYamount ofhazardous WASTE disposed of from your facility in 2017. Disposal includes HAZARDOUS WASTE picked up by alicensed transporter or taken to a certified collection your facility is in the HAZARDOUS WASTE GENERATOR Program, but no HAZARDOUS WASTE was disposed of in2017, this form is still the amount of HAZARDOUS WASTE your business disposed of during the 2017calendar Tonnage of HazardousWaste Disposed During 2017(calculation guide on back)I hereby certify that this form , including any accompanying statements, is true and correct to the best of myknowledge and :_____Date:_____Print Name:_____Phone:_____INSTRUCTIONS FOR COMPLETING THIS form ON BACKCUPA FACILITY ID.

Instructions for Completing and Submitting the Hazardous Waste Generator Reporting Form(Reporting Form) Please read these instructions carefully before completing the Reporting Form.

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  Form, Reporting, Waste, Generators, Hazardous, Hazardous waste generator, Hazardous waste generator reporting form

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